Speech! Speech!

Assuming you saw the President's address to Congress last night. Apparently The Daily Beast has highlights from it. I thought it was a bit professorial, and painfully fast-and-loose with the facts, but overall a pretty decent speech (with quite a finish).

Ultimately, I don't see this changing much. And I believe Joe "You Lie" Wilson, for all his lack of manners, probably did an excellent job of undermining Obama. If you think about the subset of people who came into the speech against Obama's reform efforts but were warming up to it as the speech went on, that sort of outburst is exactly the sort of thing to snap one out of the increasing level of trust building between the speaker and viewer throughout the speech, reminding viewers that there was a reason they opposed this guy before, and his "sweet-talk" shouldn't necessarily win them over now.

As a side note, it is sort of terrifying how divisive this issue has been, given that there's so much everyone agrees on (like pre-ex's). I mean, even the school speech was a bitter partisan issue. And Drudge Report is reporting higher readership than at the same time a year ago, which is astounding given that a year ago we were in the height of the election season (and about two weeks into the Sarah Palin Era).

I guess I'm not stupid...

...at least that's what Dr. Jon LaPook, who works for CBS and has an awesome name, tells me: "No, you're not stupid if you're confused about health care reform."

His piece in HuffPo today is about how politicians, insurers, pharmaceutical companies, etc., have intentionally made this issue impossible for most people to get a handle on. And he lays the four main goals of the legislation:

Coverage expansion and subsidies. This is where most of the estimated trillion dollar price tag over ten years would go -- to expanding Medicaid for uninsured and lower income people and to help people who can't afford it pay on a sliding scale for insurance through new health insurance exchanges.

Insurance market reforms. This is about fair play in the insurance industry. Advocates want to eliminate practices such as refusing to cover people with pre-existing conditions and jacking up premiums if they're sick. The most controversial proposal is the
establishment of a "public option" -- a government insurance plan that would compete against private ones.

Delivery and payment reforms. This is about delivering more effective care at a lower cost. About 20 percent of the 2.5 trillion dollar annual health care price tag does not contribute to better health.

Prevention. This has been long overlooked in America. Spend a few dollars on foot care for a diabetic and you may prevent a foot amputation and thousands of dollars in expenses.

I know embarassingly little about the health care system, so I'm curious as to what you guys think about this. Clearly, the reforms mentioned above are needed, but does the current legislation go about it in the right way? Is it an efficiant use of a trillion dollars? Etc. Thanks!

Video dump.

Rather than a bunch of annoying little posts I have decided to bug you with only one longer one filled with short videos.

Fenway cameraman tells you about his camera and shows you how it is controlled:

Fenway HD Camera - Sony HDC-910 - Canon 75x from Tom Guilmette on Vimeo.

The da Vinci surgical system:


Escalator spinning:


The walking table:


LSD tested on a British army group:

An Effect of a Ban on Indoor Smoking

An email from my Aunt Marcia (I have no idea when she is quoting and when she is using her own words, so I will just give you the entire email):
"Heart Attack Rates Still Fall 3 Years After Indoor Smoking Bans

Myocardial infarction rates continue to fall 3 years after indoor smoking bans are implemented, according to a study in MMWR [Morbidity and Mortality Weekly Report].

The CDC notes that nine studies have shown quick drops in hospitalizations for myocardial infarctions after laws go into effect prohibiting smoking at work and in public places, but the report is the first to show this reduction continues for several years.

The study examined the rate of hospitalization for myocardial infarction in Pueblo, Colorado, after a smoke-free ordinance took effect in 2003. Rates dropped 27% in the first 18 months and an additional 19% in the next 18 months.

'These findings provide support for considering smoke-free policies an important component of interventions to prevent heart disease morbidity and mortality,' the CDC concluded."

A new sin tax

To begin: "A study by the Centre for Science in the Public Interest showed that soft drinks were the single biggest contributor to calories in the American diet [...]"

That's right, soda beat out meat, starches, grains, fruits, and vegetables; it beat candy, cookies, and cakes. That quotation makes me feel uncomfortable drinking a soda, even if I am able to ignore the various environmental reasons for avoiding the drinks (e.g. creation of plastic bottles and draining of aquifers near bottling plants, particularly in impoverished areas in other countries (e.g. India)).

Now it seems as if Gov. Patterson is trying to change this frustrating/disgusting consumption pattern. Under Patterson's new budget plan for 2009, "[...] consumers will have to pay an 18% tax on non-diet sodas and sugary drinks." Obviously this faces resistance from drink companies and the American Beverage Association, but I am all for this policy. Sin taxes are (or at least should be) designed to discourage behavior that has a demonstrable negative effect on the person or a negative spillover effect on the community as a whole (e.g. soda leads to obesity which raises all health care costs). I think that taxing what largely amounts to a luxury good as a manner of both improving the overall level of health in the community and as a budget deficit filler is a fantastic idea. I would love to see the price of soda skyrocket to the point where it becomes as unappealing to consumers as its lasting effects are to those who actually study these effects.

Also, I have no qualms about the fact that this policy is regressive. Poverty is highly correlated with (and sometimes causally linked to) obesity, which is also causally related to soda consumption. At this point soda needs to be made a less appealing option so that money spent on calories is directed at the (slightly) healthier available alternatives as economic pressures force people to buy cheaper foods. I know that the healthy foods are the expensive foods, so it is all the more important that we push people toward the healthier end of their available consumption spectrum as their available spectrum shifts to a lower dollar level. We can take this recession and use it as a tool to shift preferences so that they take into account the true cost of the decision to drink soda. Basically, if we can get poor people to make healthy decisions we will be taking a lot of the burden off our health care system, which helps everyone and will hopefully create a positive-feedback loop that leads to lower levels of poverty (as, say, total time out of work due to poor medical treatment declines).

In the end I am actually also just happy to have another, better excuse to quit drinking soda. I hope that was coherent; I am very cold and it is pretty early.

Two interesting articles

This article is about Tom Daschle and the long-term problems that could result if Obama's health plan passes. I don't agree with a lot of it and unfortunately it is largely written from the doomsday perspective of a post-election Republican, but one point that stood out to me was that if the government picks up a program that doesn't work, it'll be like social security - we won't be able to get the people to let it go even if better solutions arise.

This article is about what closing Guantanamo would mean for US foreign/counterterrorism policy, as well as the very relevant question of what exactly we'll be doing with the detainees there.

I'd like to have a conversation going at some point about this sort of stuff, as well as torture. I'm not on the hardcore side, but in my experience, my views on torture lie to the right of most of my friends.

Healthcare and Wellness

Basically I'm asking if any of you knows any articles or research off the top of your head about incentives to change health behavior and how successful they've been. I'm asking this for this afternoon.

Now, in general, anything about making health care more efficient is appreciated because it's helpful to my job. This afternoon, however, I am supposed to give some sort of report on this stuff.

Basically, Wellness (formerly known as preventative health care) is big in the health industry. It pretty much means any lifestyle changes that can help reduce future costs. This includes everything from making sure you go to the doctor to employers beautifying their stairwells to encourage exercise.

Personally, I think it's a bit early for these ideas, but a couple of things I'm thinking about, because I definitely think they're part of the future of health plans, is:
1) Getting people to eat healthier, but specifically, in a way that would make Michael Pollan proud. I guess ideally it would be something like being able to get an employer-funded 20% discount at Trader Joe's or something like that. I know it's a bit early for the industry, but it's an idea.
2) Something even more in gestation would be an idea like Wii Fit. Now, you kind of have to get beyond the present and think about where exercise video games can be in 10 years. If employers are still footing the bill for health care down the road, I don't think it would be surprising at all to see them show up in more offices. We've got 66 people in our office, so paying $250 for a Wii plus $90 for Wii Fit isn't too expensive if it provides any returns at all ...

google, saving the world

I was very impressed with Google's developments in epidemiological tracking systems, given that people I talk to on a daily basis are frustrated with the difficulties in disseminating crucial and timely information. Google is ahead of the game- possibly 10 days ahead of the CDC! (That is an unbelievable number. Way to go, Google.)

I highly recommend checking out some of their other projects at google.org.

Obama to shift focus to health care

I sort of wondered and hoped all summer if the reason that Barack Obama was spending so little time on the economy (an issue on which the people always side with the Democrats) was so as not to "wear it out" or "use it up" so that he could drive it home in the final months.

It appears that he's doing exactly that with health care (he didn't have much choice on the economy), another issue on which Americans heavily favor Democrats. I think this is a fantastic strategy and I'm really excited, as I was just starting to wonder why they weren't discussing it more.

Here's the story and their latest ad, which is taken straight from the VP debate.